of the problem with rewarding physicians for high quality
has been the lack of objective measures. But that may not
be a problem much longer.
National Quality Forum issued 51 proposed quality standards
for ambulatory care, including care in physicians' offices,
emergency rooms and outpatient departments.
proposed "voluntary consensus standards" include
evidence-based performance measures for asthma and respiratory
conditions; depression and behavioral health; bone diseases;
heart diseases; hypertension; prenatal care; and prevention,
immunization and screening.
NQF wants to support standards that apply to individual
physicians and practices, and allow for physician accountability.
They should refer to areas of care physicians can control,
and be derived from all available data sources.
draft standards are online at www.qualityforum.org. You
have until May 16 to comment.
The Centers for Medicare and Medicaid Services issued
Transmittal 21 on April 29 instructing carriers to stop
printing patients' Medicare numbers on provider reimbursement
* The Recovery Audit Contractors (RACs) only receive payment
based on how many overpayments they recoup from providers,
but they may also identify underpayments to increase provider
good will, CMS officials insisted in an Open Door Forum
on the contractors. After all, CMS noted, the RACs may
want providers as clients in the future.
Physicians who failed to send documentation to the Comprehensive
Error Rate Testing contractor made up part of the 10.1
percent error rate for Medicare paid claims, CMS says
in a May 2 Medlearn Matters article. Providers who fail
to respond to CERT requests will find their claims deemed
in error and face overpayments. You don't need patients'
permission to send documentation to the CERT contractor.
CMS is seeking provider comment on its proposed coverage
determination that there isn't enough clinical evidence
to change its current policy banning the off-label use
of Zevalin or Bexxar. The draft decision is under number
CAG-00163 and you can find it at www.cms.hhs.gov/coverage.
A federal jury convicted Miami physicians Jorge Humberto
Forcada and Clark Carlton Mitchell of fraud. The two physicians
purportedly falsified patients' medical diagnoses and
documentation to bill Medicare for the HIV medications
Neupogen and Procrit that they never administered to patients
or weren't medically necessary, the Department of Justice